National Demand Optimisation Group (NDOG): demand optimisation in laboratory medicine - phase IV report

7 Conclusion and Recommendations

Conclusions

The Scottish Demand Optimisation Programme has demonstrated the huge value in collecting laboratory activity data and presenting it in an interactive Atlas of Variation, thus allowing observations and comparisons to be made Nationally, between Health Boards and across individual General Practices. Phase IV of the programme has also demonstrated that this data collection/display system can be modified to focus on more relevant testing trends occurring during the COVID-19 pandemic and into the recovery phase.

The trends observed clearly show dramatic reductions in pathology specimens and blood testing across all health Boards at the onset of the pandemic – much of which could be linked to reductions in related clinical activity, such as cancer diagnosis and monitoring, and chronic disease management. Recovery towards pre-pandemic levels of testing has been slow, incomplete and variable across the health Boards. The interactive atlas provides a useful tool to drill down and examine such comparative trends in detail. GP Practice level requesting data, when available, will also allow comparisons to be made at individual practice level.

Continual monitoring of activity going forwards remains important not just as a metric for clinical services recovery, but also to identify emerging pressures on laboratory services. Pathology services across the UK are very much limited by an insufficient number of histopathologists, whose work is generally capped at RCPath levels of activity. Inability therefore to deal with post pandemic increases in workload above normal levels is highly likely to lead to significant bottlenecks in healthcare pathways, notably for cancer diagnosis and management. Ongoing dashboard monitoring should be able to pick this up at health board level.

Recommendations

The Demand Optimisation programme is now at a turning point. The NDOG have developed a comprehensive Atlas of Variation and suite of recovery dashboards that are now widely promoted as a QI tool.

The next phase of work will see a programme of QI work informed by the data dashboards beginning to emerge and complementing work on care pathways including diabetes, heart disease, cancer and respiratory. It is vital that patient pathways are efficiently used and so correct use of laboratory tests where these are pivotal in directing patients is so important to ensure cost effective healthcare and allow savings to be recycled from unnecessary pathway utilisation.

A formal roll out of the test feedback documents to all NHS Boards via the NMDNs and other established networks has been planned as part of Phase V. This will allow for regular interrogation of up to date Board-level diagnostic testing data as the NHS moves through into a recovery period following the COVID-19 pandemic.

It is vital that National Demand Optimisation work continues, for both the emerging pandemic and recovery-monitoring work and to ensure delivery against the initial aims. Appropriate laboratory testing, reduction in unwarranted variation and the associated laboratory intelligence data will continue to be pivotal in informing decisions around priorities and driving COVID-19 recovery and renewal.

The following recommendations are made:

• A national oversight for Demand Optimisation of Laboratory testing is retained, further promoted, and supported in all NHS Boards.
• All Health Boards to submit required data for the Atlas of Variation and recovery monitoring dashboards. Consideration needs to be given to enhancing IT support locally to allow this to be achieved.
• Inclusion of Genetics data set in the recovery monitoring dashboards.
• Formal national rollout of the Atlas of Variation and recovery monitoring dashboards.
• Embedding of Demand Optimisation dashboards and QI toolkits in all NHS Board QI projects and teams.
• Strengthen links with Realistic Medicine leads and Demand Optimisation teams in NHS Boards across Scotland.
• Re-engage with Local Improvement Support Teams (LIST) to develop plans for tackling and responding to variation.
• Identify relevant clinical pathways to target for streamlining processes, tackling variation across all Health Boards and driving better use of resources where appropriate.